Clinical Comparative Study Of Two Kinds Of Surgical Treatment For Scaphoid Nonunion

Objective Scaphoid fracture is the most common fracture in carpal fracture.Because of its special anatomical structure,fragile blood supply and difficulty in diagnosis,scaphoid fracture has a high rate of nonunion and necrosis rate,which ultimately reduces wrist function.Although many kinds of surgical methods are put forward at home and abroad,traditional open operation is the main way,but the specific treatment methods are still controversial.In recent years,the application of wrist arthroscopy has achieved good results.Studies have shown that arthroscopic minimally invasive treatment of scaphoid nonunion has fewer complications and higher wrist function improvement.However,reports on comparative analysis of two operative methods at home and abroad is very few,therefore,this paper retrospectively analyzed the traditional open surgery and arthroscopic minimally invasive treatment of scaphoid fracture nonunion of clinical curative effect.Method A retrospective study is conducted on 42 cases(met the inclusion criteria)of scaphoid bone nonunion in Ningbo Sixth Hospital in the past 2008-2015 years,traditional open surgery group has 22 cases and arthroscopy group has 20 cases.There are 35 males and 7 females,15 left-wrist cases and 27 right-wrist cases,the average age is 32.6 + 10.4 years old,30 cases caused by falling injury,9 cases caused by crashing injury,1 cases caused by crush injury,1 cases is after surgury and 1 cases is unknown.According to Herbert and Fisher classification,there are 31 cases of D1 type and 10 cases of D2 type,(1 case is not included because of the lack of preoperative imaging data).According to the fracture site,there are 27 cases in the lumbar region,11 cases in the distal pole and 2 cases in the proximal pole.Using SPSS19.0 statistical software to analyze the clinical treatment effect(including healing time,improving of the wrist function(according to the modified Mayo wrist function system)etc.).Result Postoperatively,open surgery group and arthroscopy minimally group average follow-up time were 27.5 months and 20 months;the healing rate: 95.5%,95%,and the healing time(14.1 weeks,13.4 weeks)was no statistically significant difference(p < 0.05).Open surgery group had shorter time of surgery than arthroscopy minimally group(p < 0.01).The scores of modified Mayo wrist function system was higher in the arthroscopy group(94.4%)than in the open group(80%).The VAS score of arthroscopic group(0.7 + 0.8)is lower than the open surgery group(1.1.1.1).There was 1 case had complication in open group,arthroscopy group had no complications.Conclusion Although there are many ways of surgical treatment of scaphoid nonunion,the most widely used ones are traditional open surgery(cancellous bone graft and internal fixation),and wrist arthroscopy assisted minimally invasive surgery.Satisfactory result of fracture healing can be obtained with the two operation methods.The wrist joint function after arthroscopy surgery is better than open surgery,and it has lower VAS score and complication and better appearance,But the operation time is long,the technology is difficult,and the operator is highly demanding.